RESUMO
Objective: To evaluate the complications of percutaneous kidney biopsy in ambulatory patients in a tertiary care centre over a two year period
Study Design: Cross sectional, descriptive
Place and Duration of Study: The study was carried out at the Department of Nephrology Military Hospital, Rawalpindi from Jan 2008 to Jan 2010
Material and Methods: Patients referred to the Nephrology Department for kidney biopsy were considered for inclusion in the study provided they did not have any contraindications to the procedure and had a normotensive state with BP <130/90 mm Hg and a normal coagulation profile including partial thromboplastin time, prothrombin time, bleeding time and platelet count. Patients with an evidence of malignancy, congenital anomalies of kidneys on ultrasound examination or a skin disorder affecting the likely site of biopsy were excluded
Results: A total of 100 patients who merited standard indications for kidney biopsy were included in the study. Average age was 45.53 years [+1 SD = 10.96] with age range of 25 years to 75 years. There were 83 males [83%] and 17 females [17%] with male to female ratio of 4.9:1. Microscopic hematuria occurred in 82 [82%] patients. Gross hematuria occurred in 12 [12%] patients. Decrease in hemoglobin level by 1 g/dL or more occurred in 35 [35%]
There was no episode of hypotension secondary to severe bleeding. No patient required transfusion. Surgery was not required in any patient for controlling bleeding. Death was not recorded among the reported complications
Conclusion: Percutaneous kidney biopsy can be safely conducted as an outpatient procedure with an observation time of 12 hours post-biopsy to watch for any complications
RESUMO
Objective: To study the correlation of anti C1q antibodies with disease activity in patients with systemic lupus erythematosus [SLE]
Study Design: Cross sectional, observational study
Place and Duration of study: The Department of Immunology, Armed Forces Institute of Pathology, Rawalpindi in collaboration with Military Hospital, Rawalpindi, Pakistan Institute of Medical Sciences, Islamabad and Benazir Bhutto Hospital, Rawalpindi, from Jan 2012 to Dec 2013
Material and Methods: Patients with a clinical diagnosis of SLE were included in the study on fulfilling revised American College of Rheumatology [ACR] criteria [1997]. Main outcome measures were SLE disease activity index [SLEDAI] score and anti C1q antibody levels in serum. SLEDAI scores were calculated for each patient on the basis of physical examination, patient interviews and previous clinical records. Anti C1q antibody levels in the serum were determined by enzyme-linked immunosorbent assay [ELISA] and correlated with the SLEDAI scores by calculating Pearson's correlation coefficient 'r'. The cutoff value for anti C1q antibody positivity in the serum was determined by evaluating the serum levels of anti C1q antibodies in 25 healthy subjects and was 12 U/ml
Results: Six male and forty nine female SLE patients with an age range of 16-47 years [mean 34.5 years] and 8-70 years [mean 31.7 years] respectively were studied. The correlation between anti C1q levels and SLEDAI scores in all patients was demonstrated by calculating the correlation coefficient and was not significant [r=0.19, p=0.14]. However, there was an inverse correlation between anti C1q levels and SLEDAI scores in patients with severe disease and this was statistically significant [r=-0.448, p=0.037]. The difference in anti C1q antibody positivity between patients with and without nephritis was not significant. The anti C1q antibody levels correlated poorly with anti double stranded deoxyribonucleic acid [dsDNA] antibody positivity. A significantly higher percentage of patients with evidence of complement consumption was found to be positive for anti C1q antibodies [p=0.01]. This significance was only seen in patients with reduced C3 levels [p=0.04] and not reduced C4 levels [p=0.23] or both [p=0.23]. Anti C1q antibody levels had significant inverse correlation with serum C3 levels. [p=0.007]
Conclusion: A significant inverse correlation was found between SLEDAI scores and serum anti C1q antibody levels in patients with severe SLE. The anti C1q antibody positivity is significantly higher in patients with reduced C3 levels